12.15.17 Issue #823 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Belle DuCharme, CDPMA
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Dental Insurance Plans now include Exclusive Provider Organizations (EPO)
By Belle DuCharme, CDPMA

My patient has no benefits here because we are not in their EPO network”
Jan B., Office Manager

More choices for patients and their employers from many large insurers mean dental offices can no longer say “we accept all insurances except HMO (Health Maintenance Organization) or Medicaid.” Now practices must say whether they accept an EPO (Exclusive Provider Organization, closed panel) because there will be no benefits out of network, just like the HMO. Some EPO plans have out of network benefits for emergency services only or out of area (no EPO in the geographical area) – this must be confirmed. Unlike HMO, the EPO does not assign a provider or require referrals to specialists. It requires that all providers (specialists too) must have a contractual arrangement with the EPO in question.

It is even more necessary to perform “Insurance Verification” prior to the visit because many patients think they have a PPO (Preferred Provider Organization) when in fact the employer has purchased an EPO.

Many dentists will have to change their verbiage on websites to reflect what types of plans they are in-network with and whether they are a provider on an EPO network. This should all be verified prior to a patient entering the practice for services. Leaving it up to the patient is risking unpaid accounts and criticism from angry patients.

One of the largest dental insurers is Delta Dental. Below is information from their website and some links to help you understand this relatively new product.

Delta Dental EPO

To Patients:

PLEASE NOTE: This is a directory of licensed dentists who have signed contracts to provide professional services under Delta Dental. It is not to be considered a recommendation that a particular dentist be consulted for professional care.

For services to be covered, Delta Dental EPO members must receive treatment from a dentist who participates in the Delta Dental EPO network. Treatment performed by a dentist who does not participate in the Delta Dental EPO network will not be covered.

Every effort has been made to prepare this list accurately, but Delta Dental assumes no responsibility for possible mistakes or omissions. The dentists listed in the search results may not participate in our network for each location listed in the results. Therefore, we strongly recommend that you ask your prospective dentist if he or she participates in the Delta Dental EPO network at the desired office location where you will be receiving treatment. If you have any additional questions, please contact Delta Dental's customer service department at (800) 524-0149.

What is Delta Dental EPO?
Delta Dental EPO (Exclusive Provider Organization) is a fee-for-service program. Payment for treatment is based on a fee schedule and member copayments. Delta Dental EPO participating dentists are reimbursed based on the member copayment amount and the lesser of the submitted fee or Delta Dental’s maximum fee allowance, as payment in full when treating eligible Delta Dental EPO patients. Total payment will not exceed Delta Dental’s maximum approved fee allowance.

What are the advantages of participating in Delta Dental EPO?
Participating dentists are listed in our closed-panel directory, and members are required to receive services from Delta Dental EPO dentists. Delta Dental remits benefit payments directly to participating dentists. Participating dentists collect only copayments from Delta Dental EPO members. As with other Delta Dental programs, you and your staff will have access to Dental Office Toolkit and DASI (Delta Dental's IVR phone system) 24 hours a day, 7 days a week.

How do I know if a patient is eligible for Delta Dental EPO benefits?
You can verify eligibility and access benefits and claims information through the Dental Office Toolkit by logging on to: www.dentalofficetoolkit.com. It is recommended that you verify patient eligibility prior to rendering treatment. You also can access the DASI system 24/7 at 800-870-9988.

Most patients do not want to lose their dental providers due to a change in insurance coverage. Many have a choice given to them before enrollment. Tell patients to call you first before making a change so you can help them make a decision that allows them to stay with your practice.

Help patients choose the better option with information provided in the link below:

Need to learn more about the ever-changing dental business environment? Call McKenzie Management for a course in Dental Office Management for 2018. Commit before the end of the year and receive a $500 credit towards tuition.

If you would like more information on McKenzie Management’sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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